Abstract 10263: “High Blood Pressure Comes From Thinking Too Much”: Health Beliefs Among Couples With Cardiometabolic Disorders and HIV in Sub-Saharan Africa

Abstract

Introduction: People living with HIV are at increased risk for cardiometabolic disorders (CMD) due to chronic inflammation, immune activation, and antiretroviral therapy. In high HIV prevalence areas of sub-Saharan Africa, little is known about how HIV patients and their partners understand CMD and how health services could leverage partner support. Objective: To explore health beliefs among HIV patients with CMD and primary partners Methods: We conducted a qualitative study with 25 couples recruited from 3 HIV care clinics in Zomba, Malawi. Patients managing HIV and CMD (hypertension and/or diabetes) were enrolled first, followed by their primary partners. Semi-structured interviews were conducted separately with partners to elicit health beliefs around causality, prevention, and management of CMD. Dyadic data were coded for patterns and themes within couples and between couples, and data matrices were created to compare and contrast the findings. Results: Most participants believed that the main causes of CMD were diet, aging, and genetics, but some believed CMD was sexually transmitted or caused by viruses such as HIV. Within couples, diet and stress were the most commonly agreed-upon cause, and over half of couples believed “thinking too much” due to stress or couple conflict was a cause of CMD. Prevention beliefs included a healthy diet, exercise, avoiding HIV, using condoms, and keeping stress levels low. Management beliefs included dietary changes, taking medication or herbs, exercising, and reducing stress. Within couples, the most agreed-upon belief was that diet, particularly salt reduction, was important for prevention and management; however, within-dyad disagreement and incorrect beliefs around other aspects of a heart-healthy diet were common. Conclusion: While lifestyle factors were correctly identified as important for prevention and management of CMD, misconceptions remained around transmission through a virus or sex. Partners often differed in their views of CMD, which could interfere with CMD management. Health education programs are critically needed and involving partners may offer an opportunity to solidify knowledge in couples and foster collaborative disease management around CMD.